Basic Space Basic Space Maintainers Maintainers lecture one lecture one Prepared by: Prepared by: Dr Seyed Ebrahim Jabbarifar Dr Seyed Ebrahim Jabbarifar Associate professor Associate professor University of Isfahan Department University of Isfahan Department of Pediatric Dentistry2009 of Pediatric Dentistry2009
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Basic Space MaintainersBasic Space Maintainerslecture onelecture one
• Nance or Band/Crown Loop = Maxillary problem with 1st Permanent Molars present
• Lower Lingual Holding Arch = Mandibular Problem with 1st Permanent Molars and Permanent Incisors present
• Band/Crown and Loop= Primary 1st Molar Extraction
Must I Plan to Replace a Must I Plan to Replace a Band/Crown and Loop ?Band/Crown and Loop ?
• All depends on ERUPTION SEQUENCE
– No, in maxillary arch– Yes, in mandibular arch- may need LLHA
later– Why? Canine should exfoliate prior to eruption of 1st
premolar, making space maintainer defunct.
Space Maintainer CompetencySpace Maintainer Competency
• The following cases require space The following cases require space maintainer consideration. Assume that maintainer consideration. Assume that radiographs have been taken, there is no radiographs have been taken, there is no abnormal pathology (other than dental abnormal pathology (other than dental caries), and a successor is developing. caries), and a successor is developing.
• Please answer the questions on your Please answer the questions on your worksheets.worksheets.
Question 1Question 1
• What tooth was extracted? How old is this child?• What is the appropriate space maintainer?• Will it have to be replaced with a different space
maintainer in the future? If so, with what?
Question 2Question 2
• What tooth was extracted? How old is the child?• What is the appropriate space maintainer?• Will it have to be replaced with a different space
maintainer in the future? If so, with what?
Question 3Question 3
• Which teeth were extracted? How old is the patient?• What is the appropriate space maintainer?• When can the space maintainer be removed?
Question 4Question 4
• Which teeth were extracted/• What is the appropriate space maintainer?
Question 5Question 5
• Which teeth have been extracted? How old is the child?• What is the most appropriate space maintenance?
““Somieh” CaseSomieh” Case
• Somieh presented for an initial visit at the Somieh presented for an initial visit at the COD. She has had dental treatment on COD. She has had dental treatment on and off throughout life. She is in no pain, and off throughout life. She is in no pain, but mom reports that “we know she has but mom reports that “we know she has dental problems.”dental problems.”
How old is Ali assuming normal How old is Ali assuming normal dental development?dental development?
Ali’s Bite WingsAli’s Bite Wings
Mandibular Arch Only:Mandibular Arch Only: Chart Chart Dentition on the OdontogramDentition on the Odontogram
AliAli
• Mandibular Arch OnlyMandibular Arch Only : Chart : Chart abnormalities and pathology (including abnormalities and pathology (including caries ) from the Panorex and Bite Wing caries ) from the Panorex and Bite Wing RadiographsRadiographs
AliAli
A Moyer’s space analysis predicted there A Moyer’s space analysis predicted there to be 2.3 mm of excess space in the to be 2.3 mm of excess space in the mandible.mandible.
Make a treatment plan and appointment Make a treatment plan and appointment sequence for the mandibular arch only.sequence for the mandibular arch only.
AliAli
• Assuming normal dental development, at Assuming normal dental development, at what age will the space maintainer you what age will the space maintainer you placed no longer be needed?placed no longer be needed?
““Ali” CaseAli” Case
• Ali was referred by his general dentist for ‘ Ali was referred by his general dentist for ‘ tooth decay and crowding.’tooth decay and crowding.’
• The family does not believe they can The family does not believe they can afford comprehensive orthodontic care, afford comprehensive orthodontic care, but does have dental insurance for but does have dental insurance for “routine dental care.”“routine dental care.”
Ali: Ali: Chart Chart Maxillary DentitionMaxillary Dentition OnlyOnly on the Odontogramon the Odontogram
Ali’s Bite WingsAli’s Bite Wings
• Chart any pathology or abnormal findings (including caries) for the maxillary arch only on the odontogram.
AliAli
AliAli
A Moyer’s space analysis predicts 1.2 mm A Moyer’s space analysis predicts 1.2 mm of space shortage in the maxillaof space shortage in the maxilla
Treatment plan and sequence appointments Treatment plan and sequence appointments for the for the Maxillary Arch OnlyMaxillary Arch Only
AliAli
DiscussionDiscussion
Question 1Question 1
• 5 or 6 y.o. child. Tooth #I extracted.
Question 1Question 1
• Band/Crown and Loop #J-H• Will not need replacement. #12 should erupt
before #H or J exfoliate
Question 2Question 2
• Tooth #L extracted. 3-5 y.o. child.• What is the appropriate space maintainer?• Will it have to be replaced with a different space
maintainer in the future? If so, with what?
Question 2Question 2
• Band/Crown Loop #K-M• May need to be replaced by LLHA later. Tooth
#M should exfoliate prior to eruption #21.
Question 3Question 3
• Teeth #A and #J extracted. Patient 8-9 y.o.
Question 3Question 3
• Nance #3-#14• Can be removed when #4 and #13 erupt-around age 12
Question 4Question 4
• Teeth #K and L extracted
Question 4Question 4
• Lower Lingual Holding Arch (LLHA) #19-#30
Question 5Question 5
• Teeth #K and #S extracted. 5-6 y.o. child.• Because permanent incisors are not erupted, LLHA not
recommended. Options: Reverse band and loop #L-#19 and band and loop #T-#R.
““Ali”Ali”
• Ali presented for an initial visit at the Afzal Ali presented for an initial visit at the Afzal Clinic. He has had dental treatment on and Clinic. He has had dental treatment on and off throughout life. He is in no pain, but off throughout life. He is in no pain, but mom reports that “we know she has dental mom reports that “we know she has dental problems.”problems.”
Assuming normal dental development, Ali Assuming normal dental development, Ali is 8 years old.is 8 years old.
AliAli
• Mandibular Arch OnlyMandibular Arch Only : Chart : Chart abnormalities and pathology (including abnormalities and pathology (including caries ) from the Panorex and Bite Wing caries ) from the Panorex and Bite Wing RadiographsRadiographs
AliAli
• Teeth Present:
19, K,L,M,23,24,25,26,R,S,T,30
Restorations: SSC #L
Pathology/Caries: #L and #S abscessed,
#28 severely ectopic.
AliAli
A Moyer’s space analysis predicted there A Moyer’s space analysis predicted there to be 2.3 mm of excess space in the to be 2.3 mm of excess space in the mandible.mandible.
Make a treatment plan and appointment Make a treatment plan and appointment sequence for the mandibular arch only.sequence for the mandibular arch only.
Ali Tx PlanAli Tx Plan
• Extract #L,S and T and Place LLHA• #L and S due to abscess• #T due to ectopic #28
– Appt #1: Fit bands and Impress for LLHA
Extract #L– Appt. #2: Seat LLHA
Extract #S, T
AliAli
• Assuming normal dental development, at Assuming normal dental development, at what age will the space maintainer you what age will the space maintainer you placed no longer be needed?placed no longer be needed?
• Answer: When #21,28 and 29 erupt. Answer: When #21,28 and 29 erupt.
• Around age 12 yearsAround age 12 years
““Ali” CaseAli” Case
• Ali was referred by his general dentist for ‘ Ali was referred by his general dentist for ‘ tooth decay and crowding.’tooth decay and crowding.’
• The family does not believe they can The family does not believe they can afford comprehensive orthodontic care , afford comprehensive orthodontic care , but does have dental insurance for but does have dental insurance for “routine dental care.”“routine dental care.”
AliAli
AliAli
A Moyer’s space analysis predicts 1.2 mm A Moyer’s space analysis predicts 1.2 mm of space shortage in the maxillaof space shortage in the maxilla
Treatment plan and sequence appointments Treatment plan and sequence appointments for the for the Maxillary Arch OnlyMaxillary Arch Only
AliAli
• Teeth Present: #3,A,B,C,7,8,9,10,H,12,J,14
• Restorations: #A-MO, #B-DO.
• Pathology/Caries: #3-M; #A-D; #B-M;
#H-D;#J-abscess, #14-MO
Note: #6 and #11 very advanced root development.
AliAli
Ali Tx PlanAli Tx Plan
• Extract all maxillary primary teeth– #A,B,J- Multiple caries and near exfoliation– TE #C and #H due to root formation #6 and
#11
• Restore #3 with direct M composite
• Restore #14-MO• Place Nance Space Maintainer- slight space
deficiency, but this will be very beneficial.
Ali Tx SequenceAli Tx Sequence
• Appt 1– Fit bands #3 and #14 and Impress for Nance– Restore #14– TE #H and #J